HomeMy WebLinkAboutBuilding Permit Application All APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� � Permit Number: � J�
M
RECEIVED
Building Permit Application JAN 2 8 2020
Planning and Development Services
Building and Code Regulation Division ST. Lucie`County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 -�7
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
4
PERMIT TYPE:
i 0 F� �� I _ 3LACI S." ,
Address: i �'" 1 � . �. � �.�'-C-�
Property Tax ID#: W(��-!- ( ��'C -Ca Lot No. 16
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit-check all that apply:
—Mechanical _Gas Tank w Gas Piping ___,Shutters � Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: f Sq. Ft.of First Floor:
Cost of Construction:$ Z600 Utilities: —Sewer _Septic Building Height:
7u E•m. t
,! fit?� + t Ff A. E' 9d V .f4 e8wy
Name ,ly}i z' . Name:
Address: I CA---'1Company: Hamk L ►
City: State: Address: 1010—
Zip
t —Zip Code: Fax:Fax: City: ,F+ K-'YCSa- State:irI
Phone No. r11b' (A(n-895 1 Zip Code: 0- Fax: LALs 1-�La�
E-Mail: Phone No LAL01_� a
Fill in fee simple Title Holder on next page If.different E-Mail�
from the Owner listed above) State or County License'E a-mvolVi
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC Is$7,500 or more,a RECORDED Notice of Commencement Is required.
SU!RPL�EMENTALCON�STRUCTION LIEN LAWINFORIVIATION � 4 w., � ter _..� s2
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signathof Owner/Lessee/Contractor as Agent for Owner Sigla.at_ we of n Coractor/License Holder
STATE OF FLORIDAL STATE OF FLORIDA
COUNTY OF _ (?,( � COUNTY OF O
The 19r6ping instru ent w s acknowledged before me The fo ing instru ent was acknowledged before me
this day of 20W by this day of 2i y
s +R nn F, 1, NINUVO-S MNDU U,-
Name of person making statement. Name of person making st tement.
Personally Known�OR Produced Identification Personally Known making
Produced Identification f
Type of Identification Type of Identification
Produced Produced
_4A R
(Signature of Notary Public-State of Florida) (Signat
"""�,. KAREN S. NI S N ; YdUB`' KAREN ry Publ
Commission Qr�P"Y°b rida-No ublic Commi _State of Florida-G�a2074�e )
_ ;
=* *_ Commission # GG 207484 =p P My Commission Expires
,, M Commission Fx fires ��;;�FF;°�� June 12, 2022
June 12, 202
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DATE
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DATE
COMPLETED
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